National Framework for Quality Improvement in Behavioral ...

1 Page | 1 June 2012 National Framework for Quality Improvement in Behavioral Health Care SAMHSA has developed a National Framework for Quality Improvement in Behavioral Health Care which identifies National priorities and goals and opportunities for improving the delivery of Behavioral health services, achieving better Behavioral health outcomes and improving the Behavioral health of the population, especially those struggling with or at risk for mental illnesses and substance abuse. Efforts to implement Quality measures successfully will require an understanding of the current Behavioral health status and needs of both populations and delivery systems, as well as the ability to anticipate the data and informational requirements necessary to assess adequately and monitor changes in the healthcare environment on these same populations and delivery systems over time.

2 According to SAMHSA, the creation of a National Behavioral Health Quality Framework represents an important step in achieving the overarching purpose of SAMHSA's Strategic Initiative for Data, Outcomes, and Quality namely, realizing an integrated data strategy and a National Framework for Quality Improvement in Behavioral healthcare that will inform policy, measure program impact and lead to improved Quality of services and outcomes for individuals, families, and communities. Page | 2 National Framework for Quality Improvement in Behavioral Health Care Substance Abuse and Mental Health Services Administration (SAMHSA) June 2011 Page | 3 Overview SAMHSA can take advantage of a revitalized National interest in data activities and new technologies to establish a more robust Behavioral health information and Quality infrastructure for the Nation.

3 Taking these steps now is critical to assure that those who are most vulnerable have access to high Quality prevention, treatment and recovery services. (SAMHSA, 2011) As noted in SAMHSA s most recent strategic plan, the agency has an opportunity to capitalize on current energies, and harness resources and commitments, in developing and implementing a comprehensive yet practical Behavioral health Quality Framework to guide the collection, analysis and reporting of key information to promote improvements in the accessibility, Quality , and outcomes of prevention, treatment, and recovery services for those with or at risk for mental and substance use disorders. While a number of factors have converged to create this opportunity, the most significant of these may be the passage of National health reform.

4 Efforts to successfully implement the various provisions of the Affordable Care Act will require an understanding of the current Behavioral health status and needs of both populations and delivery systems, as well as the ability to anticipate the data and informational requirements necessary to adequately assess and monitor the law s effects on these same populations and delivery systems over time. Notably, the Affordable Care Act calls for the establishment of a National Strategy for Quality Improvement in Health Care to include National priorities and a strategic plan for improving the delivery of health care services, achieving better patient outcomes, and improving the health of the population. In much the same vein, SAMHSA is now advancing a National Framework for Quality Improvement in Behavioral Health Care (referred to henceforth as the National Behavioral Health Quality Framework ), aimed at establishing National priorities and goals and opportunities for improving the delivery of Behavioral health services, achieving better Behavioral health outcomes, and improving the Behavioral health of the population, especially those with mental illnesses and substance abuse.

5 By Behavioral health, SAMHSA refers to a state of mental/emotional being and/or choices and actions that affect wellness. Behavioral health problems include substance abuse or misuse, alcohol and drug addiction, serious psychological distress, suicide, and mental and substance use disorders. This includes a range of problems from unhealthy stress to diagnosable and treatable diseases like serious mental illnesses and substance use disorders, which are often chronic in nature but from which people can and do recover. The term is also used to describe the service systems encompassing the promotion of emotional health, the prevention of mental and substance use disorders, substance use, and related problems, treatments and services for mental and substance use disorders, and recovery support.

6 Page | 4 The Federal government generally and SAMHSA specifically plays an important role in supporting and paying for the delivery of safe, high Quality Behavioral health care, monitoring Quality and disparities, providing technical assistance, supporting research, and, in limited instances, directly providing care. However, achieving safe, high Quality , affordable Behavioral health care for all Americans will be the product of millions of local actions in local communities actions taken by doctors and nurses, patients and family members, and systems put in place by health and Behavioral care organizations, providers, payers, and care mangers to ensure high Quality , effective and reliable care. Purpose of the National Behavioral Health Quality Framework The creation of a National Behavioral Health Quality Framework represents an important step in achieving the overarching purpose of SAMHSA s Strategic Initiative for Data, Outcomes and Quality ; namely, realizing an integrated data strategy and a National Framework for Quality Improvement in Behavioral health care that will inform policy, measure program impact, and lead to improved Quality of services and outcomes for individuals, families, and communities.

7 (SAMHSA, 2011) By outlining National Behavioral health Quality priorities, goals - and recommended measures for assessing progress toward identified priorities and goals - SAMHSA will provide both leadership and coordination to myriad efforts to improve the Quality of services aimed at improving the lives of those with or at risk for - Behavioral health disorders. The first step of this process is seeking public input into the structure and content of this Framework , with particular emphasis on identifying recommended measures for assessing both SAMHSA s and the nation s - progress in improving the Quality of Behavioral health services. National Aims and Priorities Similar to the National Quality Strategy, the National Behavioral Health Quality Framework will pursue three broad aims.

8 These aims will be used to guide and assess National , State, local, Territorial and Tribal efforts to improve the Quality of Behavioral health care. Better Care: Improve the overall Quality , by making Behavioral health care more patient-centered, reliable, accessible, and safe. Healthy People/Healthy Communities: Improve the Behavioral health of the population by supporting proven interventions to address Behavioral , social and, environmental determinants of positive Behavioral health in addition to delivering higher- Quality Behavioral health care. Affordable Care: Increase the value (cost-effectiveness) of Behavioral health care for individuals, families, employers, and government. Page | 5 To advance these aims, SAMHSA will initially focus on six priorities that generally parallel those of the National Quality Strategy.

9 They are: Promote the most effective prevention, treatment and recovery practices for Behavioral health disorders Assure Behavioral health care is person- and family-centered Encourage effective coordination within Behavioral health care, and between Behavioral health care and other health care and social support services Assist communities to utilize best practices to enable healthy living Make Behavioral health care safer by reducing harm caused in the delivery of care Foster affordable high Quality Behavioral health care for individuals, families, employers, and governments by developing and advancing new delivery models While SAMHSA has proposed specific quantitative goals and measures for each of these priorities, as the National Behavioral Health Quality Framework is implemented, SAMHSA will work with stakeholders and partners to both advance and refine these efforts.

10 Importantly, these priorities can only be achieved with the active engagement of clinicians, patients, provider organizations, and many others in local communities across the country, something the National Behavioral Health Quality Framework supports. Since different communities have different assets and different needs, they will likely take different paths to achieving the six priorities. This Framework will help to assure that these local efforts remain consistent with shared National aims and priorities. It is SAMHSA s hope that this National Behavioral Health Quality Framework creates a new level of cooperation among stakeholders seeking to improve Behavioral health and Behavioral health care for all Americans. SAMHSA s Role Guided by both the National Behavioral Health Quality Framework , and SAMHSA s Strategic Initiative for Data, Outcomes and Quality , SAMHSA will be positioned to pursue a systematic and comprehensive approach aimed at collecting and analyzing existing data on Behavioral health status, care delivery and outcomes throughout the United States with the explicit goals of improving SAMHSA s ability to inform and guide policy-making and programmatic decisions regarding Behavioral health by all entities that pay for or affect access to Behavioral health care.